IMMUNE RECONSTITUTION AND SKEWED RESPONSES AFTER ART START IN HIV INFECTED UGANDANS

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1 Dale and Betty Bumpers Vaccine Research Center National Institute of Allergy and Infectious Diseases National Institutes of Health Abst#_PP_25 IMMUNE RECONSTITUTION AND SKEWED RESPONSES AFTER ART START IN HIV INFECTED UGANDANS K. Nganou Makamdop 1, J.G. Chipman 2, G.J. Beilman 2, T. Hoskuldsson 2, A. Ransier 1, F. Laboune 1, K. Ghneim 3, T.E. Schmidt 2, S.W. Darko 1, R.P. Sekaly 3, C.M. Kityo 4, T.W. Schacker 2, D.C. Douek 1. 1 Vaccine Research Center NIAID NIH, Human Immunology Section, Bethesda, USA. 2 University of Minnesota, Department of Medicine, Minneapolis, USA. 3 Case Western Reserve University, Systems Biology, Cleveland, USA. 4 Joint Clinical Research Centre, Board, Kampala, Uganda.

2 Background and aim HIV-induced inflammation drives CD4 T cell depletion and progression towards AIDS Reported associations but relationship between inflammation and infection not fully understood Leeansyah et al, Curr Opin HIV AIDS 213 Goal: Study the HIV-induced inflammation in patients on cart ARTnaïve N 11 Age (Years) Gender ratio (M/F) PB CD4 count (Cells/μl) Plasma virus load (Log HIV copies) 36 [3-4] 4:7 333 [241-39] 5.2 [ ] HIV+ ART naive Plasma virus load qrt-pcr: HIV RNA cart start Baseline Month 3-4 Month 12 Virological and immunological assessments Soluble biomarkers ELISA: IFABP, scd14 Luminex: Plasma cytokines/chemokines Cellular biomarkers FACS: 17-color panel for phenotype and sort PBMC T cell subsets Transcriptome and circulating microbiome NGS: sequencing libraries made from nucleic acids of sorted cells and plasma Median [IQR]

3 Inflammation after cart start Plasma HIV load MIP-1b IFNg 1 8 HIV RNA copies/ml pg/ml 3 1 pg/ml 6 Relative number DEGs Identified pathways Weeks T cell transcriptome Baseline Month 4 Type I IFN response Antiviral response Regulation viral replication Myeloid differentiation Regulation T cell activation TLR signalling Chemotaxis Leukocyte migration Responses to bacterium Responses to fungi 4CM 4EM 8CM 8 EM Weeks Weeks Increased inflammation under cart despite full HIV suppression 17 circulating biomarkers measured T cell immune profile suggests response to other pathogens Phenotype CD4 and CD8 subsets Th, memory, activated Transcriptome sorted T cell subsets

4 Changes in microbiome after cart start Significant changes in circulating microbiome observed after cart start in all participants Noticeable increase in relative load of several pathogenic agents Circulating microbial load relative abundance B Mo3 B Mo3 B Mo3 B Mo3 B Mo3 B Mo3 Terrabacteria Actinobacteria Firmicutes Proteobacteria Alphaproteobacteria Betaproteobacteria Gammaproteobacteria Sphingobacteria Bacteroidetes/Chlorobi Prostists Apicomplexans Fungi Ascomycetes Basidiomycetes ssrna / dsrna Viruses Flaviviridae Reoviridae Worms Flatworms Roundworms Others Insects Land Plants # 1 # 2 # 3 # 4 # 5 # 6 Paricipants timepoints

5 %CD4 Th1 cells IL8 / IL12 (pg/ml) IL8 / IL12 (pg/ml) %CD4 Th1 cells IL1b pg/ml Association microbiome and inflammation Increased inflammation correlates 6 with higher microbial burden G-CSF / IFNg (pg/ml) Conclusion and outlook Pathogen burden 6 and cytokines levels 8 Inflammation level inversely correlates with GBV-C frequencies G-CSF / IFNg (pg/ml) Pathogen burden and cytokines levels Rel. abundance Proteobacteria/Terrabacteria/Fungi IL8 pg/ml IL8 IL12A G-CSF IFNg GBV-C load and innate cytokines levels Rel. abundance Proteobacteria/Terrabacteria/Fungi Relative frequency GBV-C IL1B IL % CM CD8 T cells Pathogen burden and %T cell subsets Rel. abundance Proteobacteria/Terrabacteria/Fungi IFNg pg/ml CD4 Th1 CD8 CM GBV-C load and T cell repsonses Relative frequency GBV-C Following cart initiation, changes in the circulating microbiome are associated with exacerbated inflammation IL8 IL12A G-CSF IFNg Clinically silent immune activation could contribute to a sustained HIV reservoir and impact immunity to other infections and vaccines IFNg CD4 Th

6 Kampala, Oct 215 University of Minnesota Timothy Schacker Jeffrey Chipman Gregory Beilman Thomas Schmidt Samuel Callisto JCRC Uganda Peter Mugyenyi Cissy Kityo Francis Ssali Deborah Massira Patrick Sengendo Prossy Muloma Case Western Reserve University Rafick-Pierre Sekaly Khader Ghneim Acknowledgements Vaccine research center -NIH Daniel Douek Amy Ransier Farida Laboune Sam Darko Eli Boritz Riana Dutt Zak Yaffe Gideon Wolf James Lee Jianfei Hu Ilona Toth Spriridon Vonortas Timothy hoang Richard Koup David Ambrozak Thank you